Digging into worrisome moles

Who is a big supporter of my column? I would like to think my children, as I e-mail them copies each week. But a recent e-mail response from one of them was, "Dad, you always have such cheery thoughts, like colonoscopy! What other form of poking must you subject us to? Will it be root canals? How about some good news and something that's more dignified?" So here's a column that needs removal of clothing, but no poking.

Recently my wife asked me to check her body for suspicious moles. I didn't see any, but it's never prudent to be your wife's doctor. If I missed diagnosing a melanoma my children might suspect I was after her insurance money. So I suggested we should both arrange for a mole checkup.

Several years ago we each had a colonoscopy on the same day. That's what you call "togetherness." This time the dermatologist's nurse said, "Do you want to be examined together?" I said, "Why not? It will save the doctor time." I took off everything except my shorts. My wife said, "You don't think I'm going to take off all my clothes and stand here naked when the doctor enters, do you?" Again, I said, "It will save time".

Fortunately we were melanoma free. But each year in North America one person dies every hour due to a malignant melanoma. So what can you do to protect yourself from this disease? And how much should we shield ourselves from the sun?

The dermatologist gave us this practical advice: It's prudent to do a mole check of your whole body at regular intervals. But it's not easy to examine your own back. So if you have a partner, check each other's back from time to time.

What do you look for when examining the skin? Melanomas come in a variety of colours. Some are coal black, some darker around the outside of the mole. Still others contain a mixture of white, purple, blue and red. And some are the shade of skin.

Nearly all dangerous moles have irregular or indefinite margins. A red inflamed area is often present around the periphery of the mole and in some cases there may be satellite moles in the immediate vicinity.

A red light should flash in your head if a mole develops a tingling sensation or becomes itchy, grows larger, tender, ulcerated and bleeds easily. See your doctor immediately if there's the slightest suspicion that an innocent mole is changing in any way.

There's an old surgical saying, "when in doubt, cut it out." No doctor, of course, wants to remove a normal appendix. But it does no harm if a suspicious mole is removed, then found later to be normal.

Protect yourself from the sun. As Rudyard Kipling wrote, "Only mad dogs and Englishmen go out in the noon day sun." Too much sun exposure is a major cause of many melanomas. However, don't go to the other extreme and become paranoid about the sun. Recent research indicates that some sunlight might even help to protect against melanomas.

Dr. Eugene Butcher, professor of pathology at Stanford University, in California, studied cells in the laboratory and discovered a biochemical change that linked sunlight exposure to the skin's own immune system.

These experiments showed that a short-wave length of ultraviolet light generates vitamin D3. Various enzymes in the liver and kidneys then turns D3 into a compound called 1,25(OH)2D3 which stimulates the skin's immune system to fight infection and possibly skin cancer.

The message of this research does not mean we can all go out and bake in the sun. Rather, as in most situations in life, moderation is the best choice.

We have also known for years that sunlight stimulates the production of vitamin D, a vitamin crucial to bone health and the prevention of osteoporosis. There's also evidence that vitamin D may play a role in preventing colon cancer.

So how much sun exposure is needed? Experts suggest about 30 minutes a day. But in Canada and the northern U.S. we receive no benefit from the sun from October to February. It's therefore prudent to take 800 units of D daily during these months.